Rodrigo Rexan, Allen Angela, Manampreri Aresha, Perera Luxman, Fisher Christopher A, Allen Stephen, Weatherall David J, Premawardhena Anuja
Faculty of Medicine, University of Kelaniya, Sri Lanka; Thalassemia Care Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK; Centre for Tropical and Infectious Disease, Liverpool School of Tropical Medicine, Liverpool, UK.
Blood Cells Mol Dis. 2018 Jul;71:11-15. doi: 10.1016/j.bcmd.2018.01.003. Epub 2018 Feb 2.
Iron deficiency complicates the use of red cell indices to screen for carriers of haemoglobin variants in many populations. In a cross sectional survey of 7526 secondary school students from 25 districts of Sri Lanka, 1963 (26.0%) students had low red cell indices. Iron deficiency, identified by low serum ferritin, was the major identifiable cause occurring in 550/1806 (30.5%) students. Low red cell indices occurred in iron-replete students with alpha-thalassaemia including those with single alpha-globin gene deletions. Anaemia and low red cell indices were also common in beta-thalassaemia trait. An unexpected finding was that low red cell indices occurred in 713 iron-replete students with a normal haemoglobin genotype. It is common practice to prescribe iron supplements to individuals with low red cell indices. Since low red cell indices were a feature of all forms of α thalassaemia and also of iron deficiency, in areas where both conditions are common, such as Sri Lanka, it is imperative to differentiate between the two, to allow targeted administration of iron supplements and avoid the possible deleterious effects of increased iron availability in iron replete individuals with low red cell indices due to other causes such as α thalassaemia.
在许多人群中，缺铁会使利用红细胞指数筛查血红蛋白变异携带者的工作变得复杂。在一项对来自斯里兰卡25个地区的7526名中学生的横断面调查中，1963名（26.0%）学生的红细胞指数较低。血清铁蛋白水平低所确定的缺铁是主要的可识别原因，在1806名学生中有550名（30.5%）出现这种情况。红细胞指数低也出现在铁储备充足且患有α地中海贫血的学生中，包括那些有单个α珠蛋白基因缺失的学生。贫血和红细胞指数低在β地中海贫血特征患者中也很常见。一个意外的发现是，713名铁储备充足且血红蛋白基因型正常的学生红细胞指数较低。给红细胞指数低的个体开铁补充剂是常见的做法。由于红细胞指数低是所有形式的α地中海贫血以及缺铁的一个特征，在两种情况都常见的地区，如斯里兰卡，区分这两者至关重要，以便有针对性地给予铁补充剂，并避免因其他原因（如α地中海贫血）导致红细胞指数低但铁储备充足的个体铁摄入量增加可能产生的有害影响。
